On representation: voice, trauma and evidence in decision-making

The Child Youth and Family reforms announced a week ago are wide-ranging and contain a mixture of potential pros and cons for different populations in contact with the whole child welfare system: by which I mean statutory child protection, the wider domain of NGOs, targeted and universal services, and macro social protections. I offer this post as my first reflections, and (as these reforms provide some hearty discussion topics) look forward to the developing policy debates that will ensue.

All reforms contain the assumptions of particular ideological positions that combine with dominant ways of explaining the problems at hand to produce aims and solutions. In these reforms, several sources of knowledge are drawn on to frame the problems, propose legitimate forms of knowledge, and shape solutions. The reforms draw heavily on three sources of ‘legitimating knowledge’: the views of care leavers, the concept of trauma, and evidence based practice. None of them are especially radical or unusual per se, yet each one is used in a particular way to create a version of reality that frames the solutions offered in response. It’s worth tracing this progression in order to critically analyse the reforms and their possible impact. Let me explain.

A recent study compared the perceptions of Norwegian and English social workers of children’s expressed opinions on child protection decisions. One practitioner comments:

Too quickly [we] make a child’s view true and authentic when it’s to our advantage, but if the child disagrees then it’s more difficult … then we tend to explain this view by reference to circumstances that reduce the validity of the child’s view. I find this difficult. (Archard & Skivenes, 2009, p. 397).

Such responses remind us of the politics of representation when it comes to gathering, analysing and presenting the voices of children in the care system, or in any context. There are choices that exist around the selection of particular children, and of particular excerpts from their comments, to justify particular courses of action. So it is with our CYF review, where the voices of one particular group – a group of care leavers – has been presented in such a way as to lend justification to the resulting policy proposals.

Likewise, certain types of knowledge – those relating to ‘trauma’, and ‘evidence based practice’ – are promulgated as the driving conceptual base that, if only applied correctly, would result in better decisions about children’s care, decisions that focus more on the needs of the child. On one level, I have no problem with any of these things. In fact, it’s deeply refreshing to see the views of young people with everyday contact with the care system coming to the fore in policy development. The impact of trauma for both children and parents are an important aspect of the knowledge base for social workers, and have been for many years. Likewise, of course, a wide range of evidence is needed in relation to understanding persistent correlations related to problematic outcomes, and the impacts of intervention.

However, to imagine that these will provide straightforward answers in complex decision contexts is reductionist. Neither the views of children in care, knowledge about trauma or other evidence exist as truly objective facts, which, if only they were known, would automatically resolve the problems concerned with developing clear policy aims and improving practice decision making. Why? Because each of these things: children’s voices, trauma knowledge, and evidence, are all contestable, with many complexities when used in practice. For example, children’s views and wishes may not align with their best interests or may simply not be possible. Their views may be entangled with the power relationships within the family, shaped by family loyalties or a desire to please, and are interpreted through the conceptual lenses and personal values of social workers, judges and their own parents. Neoliberal political ideologies that value individual responsibility may select those views that result in less state responsibility and more parental blame, while those at the other end of the political spectrum may overstate children needs to ensure therapeutic intervention or support when none is needed. The complexity of the concept of trauma in practice is difficult because children experience and react to trauma differently, and the impact of trauma can be equally as devastating on parent’s lives as it is for children. Moreover, knowing about trauma does not equate to having the resources needed to respond adequately to it; and trauma, like many psychological concepts, can be used rhetorically to justify almost any course of action.

In terms of evidence, there are many differing types, much of which provides useful background knowledge for practitioners. However, evidence alone cannot direct a practitioner on what to do for this particular family or this specific child. Why? Because much of the best evidence relating to persistent correlates cannot predict which children, despite a heightened risk of a poor outcome, will or will not experience that outcome. Not to mention the complex and contested politics surrounding which types of evidence are most relevant or robust.

In the announcements associated with the CYF reforms, the ultimate and unassailable claim to an authoritative voice is when statements are premised with ‘What the young people told us was…’. Such an utterance leads me, in my naturally inquisitive way, to ask exactly who the group of young people was. That is, how they were selected from – and therefore to what extent they are representative of – the wider group of all children in contact with the child protection system. How were their stories elicited? What questions were they asked? Who chose which quotes to use? No group chosen to represent a wider group is ever perfectly representative. However, how this group’s narratives are presented in the CYF report and by politicians is worthy of examination, as many of their views are used to create justifications for a range of reforms including an increase to the age of care-leaving, increased stability whilst in care, more support for caregivers and more intensive therapeutic resources. All good things, in my view. On the other hand, these same voices are used to justify less contact with birth families, less emphasis on cultural identity or whānau connections, and earlier permanent removal from their homes. These policy directions are more problematic.

What concerns me are two things. Firstly, children in permanent, long-term care (who go on to become care leavers) make up a tiny proportion of all children involved with the wider child welfare system, and even those in contact with the existing child protection system. Why does this matter? Surely, you may ask, the important thing is that we are, perhaps for the first time, hearing and acting on the experiences of those the system is supposed to help. Well, let’s think on that. Care leavers are an important group, but they represent those with the most extreme experiences of abuse and family disadvantage, and also probably those with the most distressing experiences of being in care itself. The reforms have responded admirably to care leavers, a group for which the state assumes complete responsibility.

But beyond this small group is another, much larger group, that the state also has responsibilities towards. And I can’t help wondering if this much larger group is equally well served by a reliance on the views of the smaller group. There are around 4 – 5000 children in care each year, with about 7000 in care over the year 2013. This tells us around 2000 children move in and out of care each year, with a more stable core of kids at around the 4 – 5,000 mark. The total notifications to CYF are around 150,000 per year, with those relating to distinct children @ 60,000 in 2015. Even if we take the smaller number of distinct children, this still only equates to 8% of children in contact with CYF being in care in a given year (and the % of new children entering permanent care in a given year will be even smaller). This matters, because the remaining 92%, will never be in care (or will be so only briefly), yet they are involved with the system to some extent. They often have high needs, but they exist in a relational context where their parents have high needs that impact on their parenting.

We know that families in the broader system are represented on a social gradient, expressing widespread social inequalities. This is especially concerning for Māori, who are over represented amongst the poor. So, to what extent do the views of care leavers (and the proposed solutions) reflect the realities of these parents involved in this wider system? To frame it another way, parents are the vehicle for ensuring that children are well cared for, and that their rights to protection are enacted. Yet those adults – those responsible for ensuring the health and wellbeing of 92% of the children in contact with the child protection system – are less visible in the proposed reforms, and any action on the structural conditions affecting them is completely absent. True, there have been some attempts to gather parents’ views and voices between the interim report and the final. There is some emphasis on preventive services (something again I am very pleased to see in the reforms), yet it is uneasily juxtaposed with constant references to earlier permanent removals where prevention services are deemed unsuccessful, for example after a section on the improving of the availability of prevention services, here:

Intensive intervention when concerns escalate: Where a child is at risk of harm, the agency must be equipped to respond to ensure that child’s safety and well-being. Under these circumstances, the focus of the system is to understand the nature of the harm or potential harm caused, work intensively with families and whānau to keep children safe at home (where appropriate to do so), or make the decision quickly to get a child into a loving stable family (which may be within their extended family/whānau) at the earliest possible opportunity. This requires early identification, effective assessment, and high quality decision-making that places the needs of the child at the centre.” (Modernising Child Youth and Family Expert Panel, 2016, p.9).

Such statements contain uneasy tensions that are not easily resolved. There is no mention of reunification services pivotal to keeping children at home safely, or of parental advocacy or co-working as happens elsewhere. Compare this statement, from the US Dept of Health and Human services, for example, with the assumptions implicit in the statement above:

When children must be removed from their families to ensure their safety, the first goal is to reunite them with their families as soon as possible. Child welfare agencies implement multifaceted strategies that build on family strengths and address concerns.

This parental advocacy project organised parents involved with the child protection service to act as advocates and to co-work with social workers. It reduced the numbers of children in care in New York city from 50, 000 in the mid 1990s to less than 15, 000 in 2015. Developing these kind of partnerships and services is absent from our reforms, but could be implemented alongside the important role of advocates for children in the permanent care system, and managed by community or iwi groups. It could be an important part of the focus on prevention in the reforms, alongside offering direct preventive services.

The other big issue with decision-making is that many aspects of predicting future outcomes for a particular child are inherently uncertain. The CYF review assumes that decision making for early removal would improve, if only we understood the impact of trauma on children better, were more focussed on children’s needs. This is not necessarily the case. It’s true, some children who are later removed permanently are subjected to far too many early changes in caregiver, but it’s often only with the benefit of hindsight that this can truly be concluded. For many others, after some time in care in early childhood, they are successfully returned home. Earlier moves to permanency for those children would have robbed them of an opportunity to live with their own family in safety.

The problem is that these two groups are often not clearly distinguishable from one another. As Munro (2014) notes, conditions of uncertainty permeate child protection decision-making, and the risk factors we may observe are neither ‘necessary nor sufficient’ to say whether abuse will or will not occur again. There is no magic way to differentiate easily between those who should be permanently removed, and those who may respond to intensive preservation, because outcomes are not predictable for specific individuals (even if risk factor research – the evidence – is well understood).

This problem was played out in a recent journal discussion in Child and Youth Services Review (Bywaters, 2015, Brown & Ward, 2014). Brown and Ward (2014) argued that a failure of early decision-making to remove children meant that children were left with harmful caregivers for too long, and that this was out of step with children’s developmental needs. In response, Bywaters (2015) argued that the study was flawed on several grounds and should not be relied upon for evidence for policy. For a start, the 57 families in the study made up just 2.7% of the target children group (all children referred in a period of time). At least 20 of them had lost children before the index children into care, and just 3% were ‘no further action’ cases, compared to 57% of eligible cases. This skewed sample is similar to the group of care leavers relied upon for so much information about care in our reforms – they are a tiny and specific sample at the hard end of the whole population of families in contact with the child welfare system. Bywaters (2015) concludes that a judgement of poor decision-making based on this extremely skewed sample is unfair, as the reasons to not remove are not known. It may have been a valid decision at the time:

Throughout the reporting of the findings, the case is being made that if only a decision had been made to remove a child earlier and place him or her in a permanent alternative family, then less damage would have occurred. This is presented as a divide between making a decision and failing to do so. … When it is a judgement to keep a family together, it is characterised as ‘indecisive’. But it is possible that these are decisive judgements, decisions to support a family to stay together in the best interests of the child or because sufficient evidence for legal removal does not exist. (Bywaters, 2015, p.70).

Here, the author draws attention to the ethical components of decisions. Decisions to remove children are never only about deciding if the child has been traumatized, with the assumption being that if they have, this should equate to permanent removal. In the context of multiple disadvantages, and complex human relationships that can contain both harmful and caring elements, establishing what indeed are in the child’s best interests, and deciding to what extent parents are culpable for the harm their children experience is often unclear. As Featherstone et al. (2014) note in the UK context:

Given that the focus is overwhelmingly on those families who are multiply deprived, do services reinforce or ameliorate such deprivations? And is it ethical to remove children from their parents in a society riven by inequalities? (p.10).

So decisions to remove, while in some cases necessary, are a much more complex evaluation of ethical and legal tensions, the families’ perspectives, the child’s experiences and views, and how the living conditions, community factors and life histories of the parents are impacting on the child’s wellbeing and experience of childhood.

Removal brings its own risks of harm, and not only if the quality of foster care is poor (though of course that exacerbates the initial harm). Other studies of care leavers emphasise the sense of loss and grief experienced by some children post- removal: for example, Ros Thorpe (2007) notes that:

Ample research evidence exists of the trauma caused by disrupting children’s attachments with their family, regardless of how secure or insecure such attachments may be, and regardless of the child’s experience of even moderate levels of harm in the home … in the contemporary child protection context, a perceived ‘risk’ of harm in the home appears to be not carefully evaluated against the known risk of harm caused by removal into care (Kadushin 1980; Fahlberg 1991; Goddard and Care, 1993)” (p. 399).

It’s important that in an attempt to be ‘child focussed’, we don’t throw the baby out with the bath water (pun intended). Yes, there is a focus on prevention in the reforms, and some content that suggests, however clumsily (and with reference to a ‘market making role’) that would provide more preventive services to families. This, together with improving the quality of care options and support for care is heartily welcomed. The opportunities should be grabbed with both hands by community and iwi organisations. But the constant juxtaposition with a plea for earlier removal seems like a glowering threat to the child welfare, Māori-informed policy orientation embodied in the Children, Young Person and their Families Act 1989. Proceed with care.